- Author
-
A.E.C. Beane
- Title
- Establishing a learning health system in low and middle income countries
- Supervisors
-
C. Schultsz
A.M. Dondorp - Co-supervisors
-
C.L. Pell
R. Haniffa - Award date
- 30 September 2020
- Number of pages
- 213
- Document type
- PhD thesis
- Faculty
- Faculty of Medicine (AMC-UvA)
- Abstract
-
Poor quality care is a leading cause of excess mortality globally. In response, quality improvement (QI) interventions which have improved patients outcomes in high income countries have been championed in resource constrained healthcare settings. However, such methods have had limited success. The absence of granular data and lack of opportunities for frontline clinicians to gain the skills necessary to prioritise, implement and evaluate QI interventions, have stalled efforts to improve acute care. Learning health systems (LHS) embed knowledge generating processes to improve care in daily practice. With the aim of leveraging advancements in science, technology and practice to improve health-system performance, this thesis evaluates whether a LHS could be established in LMICs. We explored barriers to improving quality of acute care in LMICs, and then report on the design, implementation and scale up of the components of a LHS in 3 countries; a near-real time cloud based surveillance platform, and a community of practice, empowered to develop translational research, and implementation science skills to drive context-specific improvement. Subsequently we report a clinician-led evaluation of acute myocardial infarction care from admission to one year following discharge and the delivery of a peer delivered national training programme for newly qualified doctors in preparation for clinical practice. We conclude that establishing a LHS for acute care has successfully enabled a community of practice to evaluate and benchmark existing quality of care, understand contextual and organisational barriers to improving care, and deliver training to equip peers with the skills to care for acutely unwell patients.
- Persistent Identifier
- https://hdl.handle.net/11245.1/1b9745c5-bfbf-4aac-90e4-05dfeb06e3e6
- Downloads
-
Thesis (complete)
Front matter
Chapter 1: Introduction
Chapter 2: Evaluation of the feasibility and performance of early warning scores to identify patients at risk of adverse outcomes in a low-middle income country setting
Chapter 3: Determinants of recognition of the deteriorating patient in acute care wards. A qualitative study from a lower-middle-income setting
Chapter 4: Practices and perspectives in cardiopulmonary resuscitation attempts and the use of do not attempt resuscitation orders: A cross-sectional survey in Sri Lanka
Chapter 5: Addressing the information deficit in global health: Lessons from a digital acute care platform in Sri Lanka
Chapter 6: Pakistan Registry of Intensive Care (PRICE): Expanding a lower middle-income, clinician-designed critical care registry in South Asia
Chapter 7: A learning health systems approach to improving the quality of care for patients in South Asia
Chapter 8: Closing the theory to practice gap for newly qualified doctors: Evaluation of a peer-delivered practical skills training course for newly qualified doctors in preparation for clinical practice
Chapter 9: Quality evaluation and future priorities for delivering acute myocardial infarction care in Sri Lanka
Chapter 10: Outcomes and quality of recovery at one year following percutaneous coronary intervention in Sri Lanka
Chapter 11: Discussion
Summary; Nederlandse samenvatting; Word of thanks (Dankwoord); About the author; Portfolio; Contributors; List of publications
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